birth times two

When I was pregnant with Harriet, I did lots of research on unmedicated child birth. I read books and took classes. We had a doula. Our doctor was trained in water birth, and we delivered at the hospital in our area with the lowest c-section rate. I was physically, mentally, and emotionally prepared to give birth with very little intervention, and I feel really lucky to say that Harriet's birth was pretty perfect. Not only did it go off without a hitch, but it proved to be a life-changing, thoroughly healing, top-of-the-mountain experience for me.

This time around, I am becoming more and more aware that my experience will be completely different. My husband now works at a different hospital, and if we deliver there, our birth is essentially free. If we were to deliver at the hospital where Harriet was born, we would pay thousands. So the choice is obvious. This new hospital has a brand-new, beautiful mother/baby center...a far cry from the maternity ward of the hospital where Harriet was born where we had to run our tub for twenty minutes to get warm water.

This new hospital does things much differently. Most physicians are a part of a large group, so you really have no idea who is going to deliver your baby, whereas the doctor we worked with during my pregnancy with Harriet did all of my appointments and was called out of his bed at 2:00 in the morning when we needed him.

During my first appointment with my new OB group, the doctor assured me that "this isn't going to be a granola birth." She went on to explain that no hospital in our city does waterbirths for twins. She explained that I will deliver in an operating room, even if the birth is unmedicated. She also explained that there will be lots of people and lots of monitoring. If I hit 38 weeks, I will be induced. Although I really hate the idea of induction (I'd rather let the babies choose their own birthday and I know that induction makes labor much more intense), I'm actually okay with this since the stillbirth rate in twins goes up after 38 weeks. Plus, at that point, they grow better outside the womb than in it.

As far as what type of birth I'll be having, the babies and the doctors will decide. I have a little bit of power in this, but not much. If Baby A (the one who will be born first) is bigger and head down, I get to try for a vaginal birth. Otherwise, it's an automatic c-section. As of right now (26 weeks), the babies are both transverse, but Baby A is bigger.

When Baby A is born, Baby B will likely flip around due to all of the free space that suddenly opens up. Apparently, if Baby B flips breach, some doctors will literally reach their arm in while exerting pressure on the outside of my abdomen to flip the baby to a head-down position. I've heard this is the most painful part of the birth. Other doctors prefer to deliver the second baby breach and will even flip Baby B from the head-down position (using the same method I just mentioned) in order to be able to grab its ankles and deliver it feet-first. Other doctors don't flip babies at all, so if Baby B ends up breach, I get a c-section.  All of this depends on which doctor happens to be on call and what the babies do.

I do get to choose whether or not to have an epidural, and this is the part that makes me the most nervous. Assuming I'm lucky enough to have Baby A in the head down position and bigger than Baby B, I will try for a vaginal birth. I would really, REALLY prefer to do it without an epidural. Here's why:

• I've done it without an epidural before and I know I can do it again. The fact that it's twins doesn't scare me one bit, as far as the pain goes. I trust my body 100% and I know I can handle it. I've never birthed with an epidural so there's a lot of unknown there. 
• I hate the idea of that needle in my spine. When I was pregnant with Harriet, that fear was probably the main thing that led me to pursue unmedicated birth in the first place. 
• I don't want somebody telling me when to push. When I was giving birth to Harriet, I had all kinds of helpers and they were all wonderful. But it was my job to bring her into the world and I liked the fact that it was me, my body and Harriet making it happen. It was such an intimate thing, and the thought of some stranger yelling "okay, now push!" already makes me irritable. I want to feel it myself. 
• I won't go into the complications that can sometimes arise from epidurals, but from what I've researched and what I've seen friends go through, I just don't want one. I want the easiest recovery possible since I'll be caring for two newborns and a two-year-old, so I want as little intervention as possible. 

BUT if I end up having to have a c-section and I don't have an epidural in place from the beginning, they will put me completely to sleep for the remainder of the birth. This is due to the fact that they often need to get the second baby out RIGHT NOW and don't have time to put in an epidural and allow it to take full effect before making the cut.

I really want to avoid this scenario. I'm not sure how many minutes (hours?) old the babies would be by the time I woke up and got my bearings enough to hold them and nurse them. It makes me so sad to think about missing all of that time...which makes me think I should do the epidural...but then I remember that simply having an epidural makes a c-section more likely and I change my mind right back. 

I have no idea what to do. I know that I will get plenty of comments about how the most important thing is that both of our babies are delivered safely, no matter how it happens. I am 100% with you on that. That definitely is the most important thing and the day of their birth will be fully celebrated no matter how they get here. But I do want to be my own advocate in this. I want to do my research, wisely consider my options and make the choice that's best for them and for me. I also know that there's an anxious part of me that wants as much control over this process as I can get and fears that if something goes awry, everything will fall apart. For example, I'm so scared that a c-section or even just an epidural will completely derail breastfeeding. I'm worried about having one baby vaginally and the other via c-section and how that will affect bonding. I worry about all sorts of things like that.

So if you have experience with any of this stuff, I would love to hear your thoughts. Thanks (so much) in advance.

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Here's a quick update on the babies:

I'm so grateful to say that they are doing marvelously. Our growth ultrasound this week showed that they are 2 pounds (74th percentile) and 1 pound, 14 ounces (60th percentile). My cervix is right where the doctors want it to be. The fluid levels are great. We couldn't have asked for a better report.

But my OB appointment later in the week was a little sobering...and confusing. The doctor chided me for my "excessive weight gain." I have gained forty pounds thus far, and apparently I was supposed to gain 40 pounds TOTAL. No one told me this before Wednesday. In fact, I have been very purposeful about packing on the pounds. Most of the twin moms I know gained about 60-70 pounds during their pregnancies, so that's what I've been shooting for. And Dr. Barbara Luke, the author of When You're Expecting Twins, Triplets or Quads: Proven Guidelines for a Healthy Pregnancy, makes a very compelling, research-based case for gaining far more than 40 pounds during a twin pregnancy. I'm not exactly sure who to listen to or what to do about the weight issue at this point. I'm just trying to be mindful about the types of foods I'm eating and I'm watching my portions. But yeah, hearing the words "excessive weight gain" four times at your OB appointment is kind of a bummer.